Post-traumatic splenic cyst: US and MDCT findings

Author(s)

Iannacone R, Votta V, Pasqualini V, Filpo M, Lanciotti K

Patient

female, 26 year(s)

Clinical History

A patient was admitted to our department for an ultrasound examination after she had had an episode of kidney colic. An ultrasound examination done showed multiple rounded hypoechoic lesions at the
level of the spleen without intralesional vascularization on doing a color-doppler examination. Their maximal diameter ranged from 8 to 82 mm. She mentioned having been subjected to an abdominal
trauma about 10 years ago while falling off a bike. A CT scan of the upper abdomen was performed.

Imaging Findings

The patient was admitted to our department for an ultrasound examination after she had had an episode of kidney colic. The ultrasound examination when done showed multiple rounded hypoechoic lesions
at the level of the spleen without intralesional vascularization on doing a color-doppler examination. Their maximal diameter ranged from 8 to 82 mm. She was subjected to an abdominal trauma about 10
years ago while falling off a bike. A CT scan of the upper abdomen was done, which demonstrated a rounded lesion with a diameter of 8.5 cm with features consistent with those of a complex cyst,
associated with several smaller cysts. The patient underwent surgical resection of the spleen: a histologic examination that was performed confirmed the nature of the lesion.

Discussion

Splenic cysts are considered to be rare lesions. They are mainly divided into genuine or primary cysts and false or secondary cysts, based on the presence or the absence of a cellular lining,
respectively. The majority of secondary cysts have a traumatic origin and, recently, an increase of this type of cysts has been reported, most likely related to the increase in road traffic and
sports accidents. Hemorrhagic post-traumatic cysts may develop from the encapsulation of a hematoma. Subsequently, the pigment can be reabsorbed, leading to a serous cyst. Another possible mechanism
through which a trauma can produce a cyst is by the infoliation of a small, traumatic fragment of the splenic capsula. Post-traumatic cysts are found to be asymptomatic in 30%–60% of the cases.
For this reason, they are frequently detected incidentally. They may also be diagnosed after the occurrence of one of the complications, which include abscess formation and rupture caused by a
trauma. In the latter situation, acute peritonitis can occur, with hemoperitoneum and, consequently, a clinical picture of an acute abdomen. Symptoms may appear only when the size of the cyst
increases, yielding either an unpleasant heaviness or pain as this involves a space-occupying mechanism within the abdominal cavity. These symptoms can be referred to the left upper hypochondrium and
sometimes to the chest. Occasionally, pain in the tip of the left shoulder has also been reported. In addition, symptoms can be secondary to there being pressure on the surrounding organs in the
abdomen (fullness, nausea, vomiting and diarrhea). Disturbances in the chest have also been described. Indeed, pressure applied on the cardiopulmonary system may produce pain or dyspnea and
irritation of the left diaphragm, causing a persistent cough.

Thin slice MDCT of the abdomen: MPR images on the coronal plane (portal phase acquisition); the images show a splenic large hypodense mass associated with multiple smaller satellite lesions with similar imaging...

Area of Interest:unknown; Imaging Technique:Thin slice MDCT of abdomen, MPR images on the coronal plane;

Thin slice MDCT of the abdomen: MPR images on the coronal plane (portal phase acquisition); the images show a splenic large hypodense mass associated with multiple smaller satellite lesions with similar imaging...

Area of Interest:unknown; Imaging Technique:Thin slice MDCT of abdomen, MPR images on the coronal plane;

Thin slice MDCT of the abdomen: MPR images on the coronal plane (portal phase acquisition); the images show a splenic large hypodense mass associated with multiple smaller satellite lesions with similar imaging...

Area of Interest:unknown; Imaging Technique:Thin slice MDCT of abdomen, MPR images on the coronal plane;

Figure 2

Ultrasonography of the spleen

An ultrasonograph of the spleen showing a large anechoic mass (82 mm in diameter) with associated multiple smaller anechoic formations. These findings are consistent with splenic cysts.

Area of Interest:unknown; Imaging Technique:Ultrasonography of the spleen;

Thin slice MDCT of the abdomen: MPR images on the axial plane (portal phase acquisition); the CT images show a large hypodense mass of about 85 mm diameter within the spleen associated with multiple smaller satellite...

Area of Interest:unknown; Imaging Technique:Thin slice MDCT of abdomen. MPR images on the axial plane;

Thin slice MDCT of the abdomen: MPR images on the axial plane (portal phase acquisition); the CT images show a large hypodense mass of about 85 mm diameter within the spleen associated with multiple smaller satellite...

Area of Interest:unknown; Imaging Technique:Thin slice MDCT of abdomen. MPR images on the axial plane;

Thin slice MDCT of the abdomen: MPR images on the axial plane (portal phase acquisition); the CT images show a large hypodense mass of about 85 mm diameter within the spleen associated with multiple smaller satellite...

Area of Interest:unknown; Imaging Technique:Thin slice MDCT of abdomen. MPR images on the axial plane;

MDCT of the abdomen, volume-rendering reconstruction (coronal view): the image shows splenomegaly and the splenoportal trunk.

Area of Interest:unknown; Imaging Technique:MDCT of abdomen, Volume-rendering recostruction;

MDCT of the abdomen, volume-rendering reconstruction (coronal view): the image shows splenomegaly and the splenoportal trunk.

Area of Interest:unknown; Imaging Technique:MDCT of abdomen, Volume-rendering recostruction;

Figure 1

Thin slice MDCT of the abdomen. MPR images on the coronal plane

Figure 1a

Thin slice MDCT of the abdomen: MPR images on the coronal plane (portal phase acquisition); the images show a splenic large hypodense mass associated with multiple smaller satellite lesions with similar imaging characteristics.

Figure 1b

Thin slice MDCT of the abdomen: MPR images on the coronal plane (portal phase acquisition); the images show a splenic large hypodense mass associated with multiple smaller satellite lesions with similar imaging characteristics.

Figure 1c

Thin slice MDCT of the abdomen: MPR images on the coronal plane (portal phase acquisition); the images show a splenic large hypodense mass associated with multiple smaller satellite lesions with similar imaging characteristics.

Figure 2

Ultrasonography of the spleen

An ultrasonograph of the spleen showing a large anechoic mass (82 mm in diameter) with associated multiple smaller anechoic formations. These findings are consistent with splenic cysts.

Figure 3

Thin slice MDCT of the abdomen. MPR images on the axial plane

Figure 3a

Thin slice MDCT of the abdomen: MPR images on the axial plane (portal phase acquisition); the CT images show a large hypodense mass of about 85 mm diameter within the spleen associated with multiple smaller satellite lesions with similar imaging characteristics

Figure 3b

Thin slice MDCT of the abdomen: MPR images on the axial plane (portal phase acquisition); the CT images show a large hypodense mass of about 85 mm diameter within the spleen associated with multiple smaller satellite lesions with similar imaging characteristics

Figure 3c

Thin slice MDCT of the abdomen: MPR images on the axial plane (portal phase acquisition); the CT images show a large hypodense mass of about 85 mm diameter within the spleen associated with multiple smaller satellite lesions with similar imaging characteristics

Figure 4

MDCT of the abdomen, volume-rendering reconstruction

Figure 4a

MDCT of the abdomen, volume-rendering reconstruction (coronal view): the image shows splenomegaly and the splenoportal trunk.

Figure 4b

MDCT of the abdomen, volume-rendering reconstruction (coronal view): the image shows splenomegaly and the splenoportal trunk.